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State of dNifotnf ? al Protection Agency <br />Form Approved OMB No. 2050-W 9 (Expires 9-30-94) 10 See Instructions an back ge 6. <br />Please ri Form designed for use on elite (12 -pitch) typewriter. <br />UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No.,. <br />WASTE MANIFEST <br />3. Generator's Name andel Mailing Address <br />in <br />;y <br />i§1 G' f Stec e. Ua7J ? r a%�c LlGc';� 1 <br />y/ .1'0 • �a r1"�a; ��`. Gea r�®'> �� . f}.t` Yui <br />N 4. Gene'rator's Phone ) w <br />12 <br />01h 0 <br />p 5. Transporter 1 Company Name 6. US EPA ID Number <br />T E"ramn Elmronmow brVIM I CIA ID I$ IS 10161914171611 <br />� 7. Transporter 2 Company Name 8. US EPA ID Number <br />Department of Toxic Substances Control <br />Sacramento, California <br />2. Page 1 ' Information in the shad areas —.11 <br />is not required by Pede�tlaw`, <br />of <br />0 15. Special Handling Instructions and Additional Information <br />f- <br />z Wear protectft Cdottifna. DOT Guido W #31 <br />LU EftrgenW Contact: K1rkHaMrd(610)795-4400 <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified,': <br />Qpacked, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicableffederal, state and international laws. <br />V - <br />If 1 am a large quantity generator, 1 certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be, <br />economically practicable and that 1 have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future- <br />CL <br />utureh threat to human health and the environment; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br />waste mann ement method that is available to me and that 1 can afford. <br />0 Printed/Ty ed Name Signature ^ Month Day Year <br />:1 � r7> <br />V T 17. Trans orter Am <br />cknowled eent of Recei Mate ' t o Is <br />w a <br />q YPrinted/T ed Name Signature Month Day Year <br />N <br />P <br />,! <br />eIT <br />f <br />9. Designated Faatlf-�cmcl Site Address, M US EPA ID Number <br />\ <br />P <br />a': <br />18. Transporter 2 Acknowled ement of Receipt of MaterialsLU <br />V A <br />Vv, iY <br />i <br />1091 BerrynRood <br />i re ° <br />Month Day Year <br />San Jose, CA ,„ t t 15 19 14 1 tA <br />CIA lAt1 <br />ml\`a\�s..ul v: "..Yu�maZ.Caa .�.Q:\\..5.).a.,..v:Z4 <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />N19. <br />Discrepancy Indication Space <br />Q <br />:I!t r tr1 <br />t <br />V <br />A <br />/ e..;mmm <br />Z <br />! <br />I i <br />MEMO• <br />l <br />20. Facility Owner or Operator Certification of receipt of hazardous materials <br />covered by this manifest except as' noted in Item 19. <br />T <br />Printed/Typed Name <br />Signature' <br />„Month DayYear <br />MEMO <br />v <br />r <br />t DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (7/92) <br />EPA 8700-22 glow: GENERATOR RETAINS <br />"`i.S1 <br />�����\:+� aY. \�\ �\�'' .`�.\\ef4 .>.-1)r'L, T�w't�� �Yk'N'�"�, ��JZ �y� 9l^,LO `=.?`Y:Y�' �\. "ti'�\Y` \.`\Y �� \ \�.Z'.v"L ,`"Ye. Pa <br />F,.3\\\J'k�F i\. ✓�� �) L�h`\� Sy S'�,'g\i, <br />t <br />�L � S�\\ � F � 3•• Z\e`l�.?YZ `\ � �\ \, \L \1C \\ <br />5�.�YY '.. \ 4\ ,Y <br />3 \ k�1$ -:, <br />� <br />-: a. ?*S\ ?'\ ,. J \ <br />.\`), �?. YS Y. ea'�'x.� .'�Y a:�»u.:i. Y1.\ <br />0 15. Special Handling Instructions and Additional Information <br />f- <br />z Wear protectft Cdottifna. DOT Guido W #31 <br />LU EftrgenW Contact: K1rkHaMrd(610)795-4400 <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified,': <br />Qpacked, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicableffederal, state and international laws. <br />V - <br />If 1 am a large quantity generator, 1 certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be, <br />economically practicable and that 1 have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future- <br />CL <br />utureh threat to human health and the environment; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br />waste mann ement method that is available to me and that 1 can afford. <br />0 Printed/Ty ed Name Signature ^ Month Day Year <br />:1 � r7> <br />V T 17. Trans orter Am <br />cknowled eent of Recei Mate ' t o Is <br />w a <br />q YPrinted/T ed Name Signature Month Day Year <br />N <br />P <br />ce <br />ce <br />S. <br />P <br />a': <br />18. Transporter 2 Acknowled ement of Receipt of MaterialsLU <br />i <br />Printed/Typed Name <br />i re ° <br />Month Day Year <br />aL <br />0 <br />e <br />a <br />N19. <br />Discrepancy Indication Space <br />Q <br />F <br />t <br />V <br />A <br />Z <br />! <br />I i <br />l <br />20. Facility Owner or Operator Certification of receipt of hazardous materials <br />covered by this manifest except as' noted in Item 19. <br />T <br />Printed/Typed Name <br />Signature' <br />„Month DayYear <br />v <br />r <br />t DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (7/92) <br />EPA 8700-22 glow: GENERATOR RETAINS <br />